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Dispel the Stigma of Mental Illness

James T.R. Jones, a law professor at the University of Louisville, hid his bipolar disorder from employers, colleagues and students for three decades while holding prestigious jobs in public and private practice and academia. After writing a review of
The Center Cannot Hold: My Journey Through Madness (Hyperion, 2007), by law professor Elyn Saks, Jones decided to go public with his condition.

“Once I came out of the closet, I knew forever after I’d be known as ‘the bipolar law professor,’ ” Jones says. “I didn’t know how faculty, administrators and students would view a professor with a severe mental illness in light of the tremendous stigma against those with a disease like bipolar disorder. Would students still want to take my classes? Would others discount what I said, or attribute any anger or other feelings I exhibited to my illness?”

Some of Jones’ co-workers have praised him for showing that mental illness and a productive career are not mutually exclusive, while others have said nothing. “I don’t know if this is because they think it’s no big deal or if they wish I’d kept quiet and just don’t say so,” he says.

Because he had full tenure, Jones knew his job was secure, but he saw other risks in his revelation. “I am at my law school for the rest of my career, as I doubt another school would ever consider hiring someone like me,” he says. “I always counsel people who contact me to think long and hard before they go public lest stigma make their work experiences difficult and even cost them promotions or their job.”

Erasing Stigma

The Mayo Clinic’s web site calls stigma “a negative judgment based on a personal trait, in this case, having a mental health condition.” Researchers and mental health advocates link stigma and accompanying discrimination to outdated beliefs that mental illnesses don’t have the same biological bases as physical illnesses, and to persistent media depictions of people with mental illness as being dangerous.

“Stigma erodes confidence that mental health disorders are valid, treatable health conditions,” wrote Dr. David Satcher, a former U.S. surgeon general, in his landmark 1999 report on mental health. “It appears as prejudice and discrimination, fear, distrust, and stereotyping.” The report highlights attitudinal, structural and financial barriers to effective treatment and recovery from mental illness.

Eleven years later, many of these barriers still exist. While the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 may mitigate some of the financial obstacles to treatment, stigma remains even on the 20th anniversary of the Americans with Disabilities Act.

Stigma may be overt or subtle, but its effects in the workplace are widely recorded. According to the U.S. Substance Abuse and Mental Health Services Administration, stigma may deter employees from seeking help for mental illness. Mentally ill employees often continue to work in a state of distress or are absent from work. Employees who have been away from work for treatment may feel awkward and uncomfortable,observing mixed reactions from supervisors and co-workers who lack understanding or don’t know how to act or what to say about co-workers’ struggles with mental illness.

Such attitudes have enormous economic impact. The National Survey on Drug Use and Health, last conducted in 2005, found that 6.3 percent of full-time employed adults and 8.2 percent of part-time employed adults had experienced a mental illness in the previous year, with depression being the most common condition. Government estimates put the cost of mental illness to the U.S. economy at $79 billion or more per year, including $63 billion for lost productivity. It’s little wonder, then, that HR managers see a bottom-line opportunity in creating workplace cultures that support mental health and treatment of mental illness.

In a national survey released early this year by the American Psychiatric Association, fears about confidentiality and losing status at work emerged as the top reasons many American workers hesitate to seek mental health treatment. In fact, less than one-third of those with mental illnesses receive treatment, according to the Partnership for Workplace Mental Health, a program of the American Psychiatric Foundation in Arlington, Va.

HR managers are on organizations’ front lines in the struggle to overcome the stigma of seeking treatment for mental illness. Through education and advocacy, they can ensure that employees know how to access mental health services and can encourage them to do so proactively, just as they would for physical ailments. Through training, HR professionals help supervisors and managers recognize possible signs of mental illness and give them skills for working with subordinates or peers who may need referrals or support.

Support from the Top

At Emory University in Atlanta, the determination to end stigma for mental illness and treatment goes all the way up the organizational chart. After reviewing a student’s research on the stigma of mental illness on campus five years ago, Emory’s President Jim Wagner appointed a task force to study and improve access to mental health services for students, staff and faculty of the university and its health care systems. The initiative would affect the 23,000 faculty and staff members of Emory University and Emory Healthcare and their families.

The result was an assault on barriers to mental health services. The task force, led by the head of student counseling and Paula Gomes, director of Emory’s Faculty Staff Assistance Program, developed a strategy to reach the campus community. “First, we conducted focus groups and surveys on access and stigma as part of a needs assessment,” Gomes says.

Initial research revealed pervasive fear that using the mental health services of the staff assistance program would be stigmatizing. Respondents cited concerns about career advancement, image and even job loss. The task force created a video on mental health called “Colleagues at Risk” to educate employees on the services available and how to support themselves or co-workers through difficult times.

For instance, the video cited five possible warning signs of mental health problems that could merit a referral to the assistance program: high absenteeism or frequent breaks, difficulty concentrating or completing tasks, a drop in productivity, withdrawal, and angry behavior.

“We began to incorporate information about mental health and behavioral health services into all of our workshops and presentations, even those on unrelated topics,” Gomes says. Her group held workshops, “meet and greets” with counselors at campus activities, and panel discussions. Their newsletter included articles on behavioral health in every issue.

“We tried to look for points of entry wherever we could to let people know about the resources,” she says.

Outreach at Emory continues with new tools such as Step UP Emory, a program offering education about health and wellness. Last year, with “Embrace Your Mind and Spirit” as a theme, Step UP Emory helped faculty and staff members assess their mental wellness through personal assessment tools, expert information, and resources on topics such as reducing everyday stress, stages of change and transition, and managing mental illness. Former first lady Rosalynn Carter, a mental health advocate, spoke at a campus forum. Gomes said the outreach is working, with increased co-worker referrals and more managers referring their direct reports. She said many employees have become champions of the program and are comfortable letting colleagues know about the benefits of assistance services. “Our leaders are recognizing the benefits of supporting individuals in getting assistance early on, before there’s a crisis,” Gomes says. “It helps that we have this holistic model that places emotional well-being on par with physical health. It’s all connected.”

Bottom-Line Benefits

A 2007 study by the National Institute of Mental Health found that efforts to identify and treat depression in the workplace significantly improved employee health and productivity, likely leading to lower overall costs for employers. Interventions used in the study included telephone support from a care manager and participants’ choice of telephone psychotherapy, in-person psychotherapy or antidepressants.

The National Business Group on Health, a Washington, D.C.-based health policy advocacy organization for large employers, says proactive programs that address prevention and early intervention may help reduce presenteeism, absenteeism and disability claims associated with behavioral health disorders.

“All of us are touched by mental illness,” says Anne LaFleur, SPHR, vice president of human resources at Pawtucket Credit Union in Pawtucket, R.I. “We may have family members, friends or colleagues dealing with it. It’s not always obvious, so education and understanding are very important.”

With 236 employees, Pawtucket is the largest credit union in Rhode Island. LaFleur says the company is small enough to feel like a large family, yet large enough to offer strong benefits to employees. “Our wellness committee does a lot of education on mental health,” she says.

Every month, LaFleur’s staff provides health education on topics that often coincide with the national health observance calendar. Ten years ago, her team designed a program held in May to honor National Mental Health Awareness Month.

“The first time we put out fliers about depression, they disappeared almost immediately,” she recalls. The team provided a self-assessment quiz, and that got people talking openly. One employee told her colleagues she used a special light in her office because she suffered from seasonal affective disorder—she had never discussed this before.

“Our employees are open about it because we’re open,” LaFleur says. “It’s not hidden here. It’s OK for someone to say, ‘I’m seeing a therapist.’ ” Such openness takes the stigma away, according to LaFleur. Employees even post business cards of services they recommend, including therapists, on a bulletin board.

LaFleur says early intervention is critical. Many times she has called the employee assistance program with an employee sitting in her office to help begin the conversation. “Our managers do the same,” she says.

In her quest to expand education on mental health, LaFleur recently attended a four-day Mental Health First Aid training program offered by the National Council for Community Behavioral Healthcare of Washington, D.C. “It was eye-opening,” she says. “Mental illnesses often have a more serious impact because they affect so many aspects of life. As HR professionals, we need to be more aware, to see symptoms a little better and to ask the right questions.” LaFleur plans to have all her managers take the class.

Slow Progress

HR managers who want to reduce stigma and foster workplaces that encourage mental health might be surprised to know that so far, the profession gets a failing grade. The American Psychiatric Association study released this year reported that only 40 percent of respondents said their employers are supportive or extremely supportive of workers seeking care for mental health concerns.

Emory’s Gomes acknowledges that there’s still much more to do. Some employees ask for off-hours appointments so they won’t be seen entering an assistance program facility, while others will only do consultations by phone. She reminds employees that people use the assistance program for parenting consultations, nutrition coaching and more—not just for mental health services.